How HCA Healthcare’s scale allows us to improve healthcare

By Michael Cuffe, MD, MBA, Executive Vice President and Chief Clinical Officer, HCA Healthcare

Many people know HCA Healthcare as an expansive healthcare network. We deliver safe, high-quality care at 190 hospitals and more than 2,500 other sites of care through 44 million annual patient encounters; more than any other U.S. healthcare system.

Perhaps less understood is how scale enables us to address some of the greatest issues facing the country, broadly supporting both medical learning and healthcare transformation. We are uniquely positioned to identify and create workflow efficiencies, to be resilient in the face of challenges or disasters, and to learn and innovate at scale. While no single entity can influence the entire $5 trillion U.S. healthcare system, we are tackling some big challenges:

• Creating tomorrow’s workforce of physicians and nurses through training programs
• Continually improving patient safety and quality.
• Solving for technology and process improvements to streamline workflows and improve patient experience and outcomes.  In doing so we can lower the cost of healthcare access and simultaneously improve care.
• Providing for our communities in the face of emergencies and large-scale disasters

HCA Healthcare’s data, resources and people allow us to continually improve patient care in ways that reach beyond the walls of our facilities.  

Improving care at HCA Healthcare facilities can improve care everywhere

Improving the way healthcare is provided is something that is part of our culture. Since our founding in 1968, HCA Healthcare has sought to eliminate unwarranted variation in patient care by promoting evidenced-based practices and best standards.

Related article: Quality care made possible by scaled resources

Today, we maintain one of the world’s largest databases of hospital outcomes. We invest in technology that enables us to look back into the “collective memory” of care to develop new best practices and look forward to help ensure better patient outcomes.

HCA Healthcare physicians and researchers have built an increasingly sophisticated, and now AI-enabled, data ecosystem to elevate our efforts. In turn, we disseminate our findings through research publications and other channels so others can learn from our work.   Importantly, we use our data to foster hospital readiness in emergencies for our more than 190 hospitals nationwide. Our concentrated efforts to manage critical elements of emergency operations, including leadership engagement and collaborating with local officials and other health systems, allows us to respond quickly and efficiently to natural disasters such as hurricanes (including the devastating Hurricane Helene in North Carolina last year), wildfires and tornadoes, as well as events such as mass shootings.

Related article: A trauma service line that’s changing lives

To understand how we’re improving healthcare, let’s look at one aspect of a surgery: recovery. The stress of surgery on the body and the use of narcotic medications to manage pain can prolong a patient’s recovery.

To improve surgical recovery, in 2021 HCA Healthcare studied 141,482 joint replacement, gynecologic oncology, colorectal and bariatric surgeries. The team discovered that six tactics imported from a European surgical recovery program – focusing on nutrition, pain management and mobility – significantly improved recovery, reducing the average length of hospital stays by two days and decreasing narcotic pain medication use up to 44%. We codified these tactics into our Enhanced Surgical Recovery (ESR) program and now use it at all of our hospitals.

Speaking of surgical recovery and outcomes, we are improving care through our leadership in best practices in robotic-assisted surgery. HCA Healthcare does more robotic-assisted surgery than any other healthcare system — with more than 1 million cases — and our surgeons have led with many robotics “firsts” in the world. In addition, we have developed one of the largest databases on robotics surgery.

Our investment in technology, our scale and constant study of our care helps us deliver some of the most technologically advanced surgical outcomes in healthcare. Optimal outcomes associated with robotic procedures are lower rates of intra and post-operative complications, including wound infections, blood loss and transfusions, as well as shorter hospital length of stay, fewer readmissions and shorter recovery time.

We systematically support the development of our surgeons into leaders at scale. We integrate robotic training and ESR into our Graduate Medical Education programs, develop existing surgeons into experts with advanced skills, and teach advanced techniques to surgeons across other health systems.

Related articles: Research-driven care fulfills our mission and moving medicine forward through clinical trials and research

Our landmark research to reduce hospital-acquired infections is making patients everywhere safer. Patients in intensive care units (ICUs) generally experience higher rates of healthcare-associated infections (HAIs). According to the Centers for Disease Control (CDC), on any given day, about one in 31 hospital patients experiences such an infection.

To determine a best practice to prevent ICU infections, HCA Healthcare partnered with the CDC, Harvard Pilgrim Health Care Institute, and the University of California–Irvine to study prevention methods across more than 800,000 ICU patients at 137 hospitals in 18 states. The Mupirocin-Iodophor Swap Out Trial found that a combination of nasal mupirocin and chlorhexidine bathing was the most effective protocol to prevent HAIs in ICU patients.

The Swap Out Trial adds to a growing set of evidence that suggests decolonization, reducing the amount of bacteria on the skin and in the nose, can protect patients from infection. We worked with the same scientific group to conduct the REDUCE MRSA Trial, and the ABATE Infection Trial which showed that the decolonization of hospitalized patients with medical devices reduces both bloodstream infections and antibiotic-resistant pathogens. These studies represent some of the most important advances in hospital medicine.

The Swap Out study, published in the Journal of the American Medical Association in 2023, was purposely designed to set a new national standard.

Related article: Large clinical trials find a highly effective method to select appropriate antibiotics for patients hospitalized with abdominal or skin and soft tissue infection and pneumonia and urinary tract infections

HCA Healthcare is an ideal host for large healthcare studies. Our scale allows for the research, and our technology enables us to capture and analyze the results to better inform American medicine. Because such studies are conducted at a wide range (of size, complexity, and geography), of U.S. hospitals, the results should be applicable to hospitals across the country.

Related article: Clinical trial by Harvard Pilgrim Health Care Institute, HCA Healthcare, UCI Health and CDC identifies strategy to rapidly detect and respond to hospital outbreaks using algorithm-driven technology

Educating tomorrow’s healthcare workforce

Healthcare systems are improved by the people who operate them. With the nation facing both a nurse and physician shortage, HCA Healthcare has leaned into both nurse and physician education.

Related article: How do you draw 44,000-plus doctors to one health system? Focus.

To increase clinical education capabilities, HCA Healthcare now operates the Galen College of Nursing, one of the nation’s largest nursing schools, with 24 campuses. We also sponsor more graduate medical education (GME) programs for physicians than any other health system in the U.S.

We’ve deepened partnerships with Belmont University, Educate Texas, the Consortium of Florida Education Foundations and others to create more access to careers in healthcare.

While these investments support the professional development of HCA Healthcare colleagues, Galen nurses will also find roles in other U.S. hospitals and facilities, just as not every physician we educate will affiliate with HCA Healthcare facilities. Nonetheless, the platform our scale provides enables us to go where other community health systems have not, or cannot, to help address the U.S. clinician workforce shortages that are a challenge for hospitals across the country.

Related article: The Exec: HCA Healthcare aims to ‘change the national statistics’ with aggressive nurse education strategy

Improving care delivery at the bedside

Clinicians – nurses, physicians, therapists, technicians and other care providers – are the driving force behind our hospitals. They bring deep expertise, specialized skills and compassion to patients. As a learning health system, we leverage not only data and research but the voices of our clinicians to improve care. The best hospital environments enable nurses and physicians to spend as much time as possible at the bedside, where they make the greatest impact on patient care. That’s our collective goal.

We have deployed an array of technologies, some AI-enabled, and designed new team structures to improve communications and nurse workflow. Our first truly digital artificial intelligence-driven operational solution, Timpani, is now used by nearly 80 HCA Healthcare hospitals to schedule nursing shifts. It aims to give nurse leaders time back, better match staff to expected patient populations, and help to best honor nurses’ scheduling requests.

We also recently introduced new technology to support HCA Healthcare’s clinical nurse coordinators (CNCs) to help them receive real-time information about each nursing unit’s health and patient needs. The monitoring system knows what is scheduled with each patient, each shift, and alerts the coordinators when a patient is behind schedule or a nurse appears overloaded so they can rebalance patient loads mid-shift if necessary.

Related article: Chief Nurse Executive prioritizes ‘voice of the nurse’ to improve satisfaction and retention

As part of our goal to reduce administrative burden for our clinicians, we’re developing and implementing innovative AI technologies.

We’re implementing Augmedix Go, an AI-powered, hands-free mobile app. 114 providers piloted the app in six HCA Healthcare emergency rooms in 2024, and we’re now using it in both outpatient and inpatient settings. Augmedix Go uses ambient speech technology, Natural Language Processing (NLP), and generative AI, to help physicians capture data and create medical notes directly from their conversations with patients.

Related article: HCA Healthcare, one of the largest healthcare organizations in the world, is deploying generative AI

Our scale affords us both the privilege and obligation to advance the science of patient care in ways that improve care beyond our own hospital system.

To truly move healthcare forward, we must improve workflow and systems of care to give clinicians the time, tools and information to focus on what matters most – delivering high-quality care to each patient and advancing the health of entire communities.